Healthcare Provider Details

I. General information

NPI: 1952036824
Provider Name (Legal Business Name): LILLAC COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 W DISCOVERY LOOP
WASILLA AK
99654-1283
US

IV. Provider business mailing address

PO BOX 874252
WASILLA AK
99687-4252
US

V. Phone/Fax

Practice location:
  • Phone: 907-866-2108
  • Fax:
Mailing address:
  • Phone: 866-210-8282
  • Fax: 907-802-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA JOLENE MILLER
Title or Position: CEO
Credential: LPC, LMHC
Phone: 866-210-8282